Healthcare Provider Details

I. General information

NPI: 1548243736
Provider Name (Legal Business Name): MICHAEL JOHN REED DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12225 GREENVILLE AVE # 110
DALLAS TX
75243-9362
US

IV. Provider business mailing address

12225 GREENVILLE AVE STE 110
DALLAS TX
75243-9362
US

V. Phone/Fax

Practice location:
  • Phone: 214-750-6860
  • Fax: 800-986-1139
Mailing address:
  • Phone: 214-750-6860
  • Fax: 800-986-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13126
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: